m6A RNA methylation regulator-based signature for prognostic prediction and its potential immunological role in uterine corpus endometrial carcinoma

Background Uterine corpus endometrial carcinoma (UCEC) is the most common female pelvic malignancy worldwide. N6-methyladenosine (m6A) plays an important role in various cellular responses, especially in cancer progression. However, the correlation between prognostic UCEC and m6A RNA methylation regulators remains unclear. Methods We used The Cancer Genome Atlas (TCGA) to provide a gene signature that could improve the prognostic evaluation of UCEC patients according to the distinct genetic trait of m6A RNA methylation regulators from a bioinformatics perspective. After comparing UCEC subgroups with different genetic profiles of m6A regulators, we identified 71 differentially expressed genes associated with overall survival (OS) and generated a nine-gene signature through least absolute shrinkage and selection operator (LASSO) Cox regression analysis. Finally, we used in vitro and in vivo tumor cell experiments as well as the immune correlation analysis to verify the function of each gene in the proposed gene signature. Results Time-dependent receiver operating characteristic (ROC) curves revealed that the proposed gene signature could predict the outcome of UCEC patients accurately. We found that CDKN2A mainly acted from the perspective of tumor cells, while COL4A4, PXDN, TIGIT, CHODL, LMO3, KCNJ12, L1CAM, and EPHB1 might play a role in UCEC from an immunological point of view. Conclusions From an epigenetics perspective, the m6A RNA methylation regulator-based gene signature can predict the prognosis of UCEC patients and immune therapeutic efficacy. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10490-x.

and early diagnosis. However, most patients face a risk of recurrence after surgery or multi-therapies, leading to a poor prognosis. Thus, it is urgent to identify novel therapeutic targets and prognostic biomarkers to provide personalized treatment for UCEC. In recent years, comprehensive studies of new prognostic signatures based on epigenetic characteristics have been elucidated [3,4]. Cancer cell-intrinsic epigenetic alterations have been associated with carcinogenesis and tumor progression. However, few studies have reported prognostic signatures based on epigenetics in UCEC, possibly because epigenetics is not widely studied in UCEC. N 6 -methyladenosine (m 6 A) methylation modification refers to the addition of a methylated group to the N6 position of adenosine, which is the most abundant internal modification of eukaryotic mRNA and lncRNA relative to N 1 -methyladenosine (m 1 A) and 5-methylcytosine (m 5 C) [5]. Modification by m 6 A is a dynamic and reversible process, which is regulated by m 6 A methyltransferases, m 6 A demethylases, and m 6 A-binding proteins, i.e., writers, erasers, and readers (WERs). In the process, methylation and demethylation can occur simultaneously. The installation of m 6 A can affect alternative pre-mRNA splicing, 3′-end processing, mature mRNA nuclear export, and mRNA degradation. Therefore, it can affect gene expression at the transcriptional level in several ways and is directly linked with protein translation [6,7]. Methylation of mRNA m 6 A is essential for different physiological activities, including human diseases, by impacting gene transcription [8]. The m 6 A regulators are closely associated with the malignancy in various cancers because m 6 A regulators can directly affect the expression of oncogenes or tumor suppressors, and certain m 6 A regulators serve as prognosis biomarkers for certain cancers [9,10]. The m 6 A methylation in nearly 70% of endometrial tumors is reduced, thus promoting the proliferation and oncogenicity of endometrial cancer cells [11]. However, the correlation between UCEC prognostics and m 6 A RNA methylation status remains unknown.
Recently, numerous studies have found that m 6 A modification can participate in regulating the composition of the tumor microenvironment (TME) infiltrating cells to modulate the immune response [12]. For example, RNA methyltransferase METTL3-mediated m 6 A methylation can promote dendritic cell (DC) activation and antigen-presenting cells (APC)-based T cell response [13]. YTHDF1 depletion can enhance CD8 + T cell-related response and immuno-therapeutic efficacy of PD-L1 checkpoint blockade [14]. Therefore, m 6 A modification status can modulate the efficiency of the antitumor immune response, the immune-therapeutic efficacy, and the overall survival (OS). Since epigenetic reprogramming is more likely manipulated by targeting epigenetic modifiers, epigenetic biomarkers may offer additional advantages [15]. However, until now, the relevance between m 6 A regulators and TME in UCEC remains unclear. Thus, an inquiry into m 6 A methylation may provide more possibilities for predicting immune therapeutic efficacy and the prognosis of UCEC.
With the rapid growth of high throughput sequencing technologies, there is an opportunity to obtain an intact picture of the mutation and transcription landscape of most tumors with even more clarity. Herein, we explored the landscape of m 6 A regulators in a UCEC cohort from The Cancer Genome Atlas (TCGA) database. We subgrouped UCEC patients according to their genetic alterations in m 6 A regulators because alteration in even one m 6 A regulator could lead to a dysfunction of m 6 A RNA modification, resulting in dysregulation of gene expression [16]. Then, we compared the molecular, clinical, and immunological characteristics between groups with distinctions of m 6 A regulators using a least absolute shrinkage and selection operator (LASSO) Cox regression analysis. A nine-gene prognostic mRNA signature was generated to predict the OS of UCEC patients. Finally, the function of each gene in the proposed gene signature was verified using in vitro and in vivo tumor cell experiments as well as the immune correlation analysis. The result shows that CDKN2A mainly acts from the perspective of tumor cells while the remaining genes mainly act by regulating the immune response. Therefore, the m 6 A RNA methylation regulator-based signature can provide a robust and stable prognostic tool and help probe the potential therapeutic target for UCEC treatment from the perspective of epigenetics.

Datasets for analysis
All paired clinical data and transcript profiles of UCEC samples were obtained and trimmed from the TCGA Data Portal by R package "GDCRNATools" and all the somatic mutations were available from the mutation annotation format (MAF) file on the TCGA website directly. A total of 530 UCEC samples were retained, and only patients with somatic mutation data and complete follow-up clinical information were screened for subsequent studies. Based on the R package "caret", TCGA UCEC profiles were randomly separated into two parts: 75% was the training set, and 25% was the testing set. All methods were carried out in accordance with relevant guidelines.

Visualization of genetic alterations in m 6 A regulators
A total of 20 representative m 6 A regulators, including ten readers, eight writers, and two erasers, were selected from recently published studies. Before further analysis, all gene symbols of these m 6 A regulators were converted into HUGO Gene Nomenclature Committee (HGNC) symbols by manual curation from Ensembl (http:// asia. ensem bl. org/ index. html). The R package "maftools" was used to summarize, analyze, and visualize the somatic mutations [17]. The summary of the MAF file was visualized as a waterfall plot, showing the number of variants in each sample. The variant allele frequency of gene mutations, shown as a boxplot, was defined as the reading of variants divided by the total reading.

Recognition of m 6 A-related differentially expressed genes (DEGs)
Alterations in m 6 A regulatory genes were screened in each UCEC sample as above. Subsequently, one cohort was separated into two subgroups: one group with m 6 A alterations and one without m 6 A alterations. The R package "Deseq2" was adopted to generate the DEGs, which depended upon a negative binomial distribution between the two groups. P < 0.05 and |log 2 Fold-change| ≥ 1 were taken as significance criteria for DEGs. The R package "pheatmap" was adopted to conduct unsupervised learning clustering and plot the heatmap.

Immune cell composition estimation and gene ontology (GO) enrichment analysis
Tissue-infiltrating immune and other stromal subpopulation abundances based on mRNA expression were estimated by the MCP-counter method implemented by the R package "MCPcounter". The immune cell composition estimation results were visualized using the R package "vioplot" in a violin plot. The online web server g:Profiler (https:// biit. cs. ut. ee/ gprofi ler/ gost) was used to perform an ordered GO enrichment analysis, where genes are in the order of decreasing importance [18]. Then, pathway enrichment was visualized and interpreted with the Cytoscape (V3.8.0) desktop application and the "Enrich-mentMap Pipeline Collection" plug-in.

Modeling of m 6 A-related signatures for forecasting OS
The R package "glmnet" was used to conduct the LASSO Cox regression model via penalized maximum likelihood. The optimal cut-off point for distinguishing between high-and low-risk rating groups was determined using the R package "survminer" based on log-rank statistics. The m 6 A score formula was generated, and the risk score of each patient was calculated as follows: where Coef i means the coefficient and Exp i is the expression of each m 6 A-related mRNA. Receiver operating Coef i × Exp i characteristic (ROC) curves and area under the ROC curve (AUC) were used to quantify the sensitivity and specificity of the prognostic signature through the R package "timeROC".
Tools for further analysis of the m 6 A signature GETPIA 2 (http:// gepia2. cancer-pku. cn/) [19], an enhanced web server for large-scale expression profiling and interactive analysis, was used to determine the relevance of the m 6 A signature gene expression and clinical outcome across various cancer types. CIBERSORT (https:// ciber sort. stanf ord. edu/) [20], an analytical tool to estimate the abundances of member cell types, was used to calculate the correlation between the indicated gene and tumor-infiltrating immune cells. RMBase v2.0 (https:// rna. sysu. edu. cn/ rmbase/) [21], a comprehensive database to integrate epi-transcriptome sequencing data for exploring post-transcriptionally modifications of RNAs, was used to decipher different RNA modifications of the signature, including m 6 A, N1-Methyladenosines (m 1 A), pseudouridine (Ψ) modifications, 5-methylcytosine (m 5 C) modifications, 2′-O-methylations (2′-O-Me). M6A2Target (http:// m6a2t arget. cance romics. org/) [22], a comprehensive database for the target gene of WERs of m 6 A modification, was used to illustrate the correlation between WERs and the m 6 A signature.

Western blot assay
Western blot assay was performed as previously reported [23]. In brief, the proteins from Ishikawa cells were exacted with RIPA lysis buffer (Sigma-Aldrich, St Louis, MO). The concentration of proteins was measured with a BCA assay kit (Bio-Rad Laboratories, Hercules, CA, USA). The 10% SDS-PAGE isolated protein was transferred to a 0.22-μm nitrocellulose (NC) membrane (GE Healthcare, Piscataway, NJ, USA). The membranes were blocked at room temperature with 5% non-fat milk for 2 h. Then, the membranes were incubated in specific primary antibodies including COL4A4 The membranes were washed with 0.1% TBST three times for 5 min, and then incubated with antimouse or anti-rabbit horseradish peroxidase-conjugated secondary antibody (Cell Signaling Technology, Danvers, MA, USA) for 2 h, and washed with 0.1% TBST three times for 5 min each. Chemiluminescent ECL Plus reagents (Pierce, USA) were added to visualize the reaction products. The membranes were scanned with Tanon 5200 (Tanon, Shanghai, PR China). The band intensity was measured by densitometry using the Quantity One Software (Tanon, Shanghai, PR China). The protein levels were normalized with that of β-actin. All experiments were repeated in triplicate, and the representative results were shown.

MTT, Colony formation, Transwell, and wound healing assays
MTT, Colony formation and Transwell assays were performed as described previously [23]. Cell migration was also performed with a wound healing assay. Ishikawa cells transfected with the shCOL4A4, shPXDN, shCDKN2A, shTIGIT, shCHODL, shLMO3, shKCNJ12, shL1CAM, shEPHB1 and shCtrl were seeded in 6-well microplates, and scratches were generated using micropipette tips when 90% confluence was reached. Cells were washed 3 times using sterile PBS to wash off non-adherent cells generated by the scratch, and a fresh serum-free medium was replaced to continue culturing the cells. The wound status was observed at 0 h and 72 h after scratching with an X71 inverted microscope. The means of intercellular distances were calculated using the ImageJ software. All experiments were duplicated thrice.

Xenografted tumor model
Four to 6 weeks old (average weight: 15 g) BALB/c nude mice (male/female ratio 1:1) were obtained from the Shanghai Institute of Materia Medica, Chinese Academy of Science, and maintained under specific pathogen-free conditions. No statistical method was applied for the sample size estimation for the animal study. Each experimental group had enrolled 4 nude mice in an unrandomized manner to ensure the precision of the results. The experimental protocol was approved by the Wannan Medical College Animal Experimental Ethics Committee and reporting of these experiments complied with the ARRIVE (Animal Research: Reporting of In Vivo Experiments) guidelines. The cells (2 × 10 6 Ishikawa -shCDKN2A cells and Ishikawa-shCtrl cells) were injected subcutaneously into the right dorsal flank. The tumor sizes were measured using a Vernier caliper every day when the tumors were readily visualized. Tumor formation in nude mice was observed by measuring the tumor volume calculated by the following formula: volume = (length × width^2)/2. On day 35, animals were euthanized, and tumors were excised and weighed. The exclusion criteria of animal experiments are that the bodyweight of the mouse was statistically significantly changed compared to the others. The xenograft tumor was festered seriously and influenced the measurement of tumor volume.

Statistical analysis
Correlation analysis was conducted using the Pearson correlation method. The chi-square test was applied to compare the clinical-pathological features among different groups. The Mann-Whitney U test was adopted to compare the difference between genetic patterns. All statistical analyses were performed using R software (version 3.6.3) in the RStudio program (version 1.3.1073).

Landscape of genetic alterations in m 6 A regulators in TCGA UCEC patients
Among 530 TCGA UCEC cases that were analyzed, 153 samples from all cases had a genetic alteration in the m 6 A regulator with a frequency of 28.9%, and missense mutations had a leading role. The frequency of genetic alteration in the m 6 A writer gene ZC3H13 (11.9%) was the highest, followed by YTHDC2 (8.7%), YTHDC1 (6.6%), IGF2BP1 (6.0%), and RBM15 (5.3%) ( Fig. 1A; Table 1). Figure 1B shows the variant allele frequency of gene mutations, which refers to the ratio between the number of mutants and wild-type DNA copies, which estimates the clonal status of mutated genes (Fig. 1B). We searched for alterations in m 6 A regulatory genes in each TCGA UCEC sample. Then, TCGA cohorts were separated into two subgroups: one group with m 6 A regulator mutations and one group without m 6 A regulator mutations. Considering that an alteration in only one m 6 A regulator can lead to a dysfunction of m 6 A RNA modification, these two groups can represent two scenarios (a normal status and an abnormal one) of the m 6 A level.

Relationship among genetic alterations, m 6 A gene expression, and clinical phenotypes
We explored the relevance of genetic alterations, m6A gene expression, and the clinical phenotypes of UCEC patients. The results demonstrated that alterations in m 6 A regulators were only significantly related to age, not clinical stage and race. In Table 2, values in bold with an asterisk indicate a statistically significant difference (P < 0.05) using the chi-square test and demonstrate that genetic alterations in m 6 A regulators are more likely to occur in UCEC patients younger than 60 years of age. Supplementary Fig. 1 shows the decreasing trend of mRNA levels of ALKBH5, FTO, METTL16, and RBM15 by the Mann-Whitney U test. It seems that genetic alterations, especially single-nucleotide substitutions by missense mutations, may not impair most mRNA expression. However, a single nucleotide alteration in the DNA sequence of a gene can produce the wrong amino acid, thus affecting the three-dimensional structure and biological function of an m 6 A regulator protein.

GO analysis for differentially expressed mRNAs
A DEG analysis was conducted to recognize distinct patterns between subgroups with these two different m 6 A profiles. A total of 124 mRNAs passed the threshold screening. As shown in the heatmap ( Fig. 2A), 23 up-regulated genes and 101 down-regulated genes are ranked by Pearson distance, indicating that m 6 A regulator-related genetic alterations can decrease most gene expression. GO analyses were conducted on these 124 genes. The results show that these differentially expressed mRNAs are mainly enriched in biological processes associated with T cell activation. A word cloud analysis shows that cell, regulation, and proliferation are the most frequent words enriched in GO terms (Fig. 2B). Therefore, m 6 A modification can affect the occurrence and development of tumors.

Relationship between genetic alterations and immunological characteristics
Considering the potential roles of T cells above, the tissue-infiltrating immune and other stromal subpopulations abundances in UCEC groups with distinct m 6 A regulator traits were estimated to further explore the immunological role of m 6 A modification. The results are shown in the violin plot in Fig. 3, suggesting that cytotoxic lymphocytes and natural killer (NK) cells both can kill target cells and exhibit higher proportions in the UCEC group with alterations in the m 6 A regulator (Fig. 3). The results are consistent with the GO enrichment results above. In contrast, endothelial cells have the opposite role. There were no significant inter-group differences for other types of immune cells. These results show that distinct levels of m 6 A can lead to differential immune cell composition, thereby influencing the immune responses.

Generation of m 6 A gene signature from the training set
A total of 71 prognostic genes were generated by manipulating a univariate Cox model, revealing an association between the expression level of mRNAs and the OS of patients (P < 0.05). To reduce dimensionality and select representative m 6 A-related markers for forecasting the OS of UCEC patients, a LASSO Cox regression model was performed according to the minimum criterion in the training set. Nine m 6 A-related genes, CDKN2A, TIGIT, COL4A4, PXDN, CHODL, LMO3, KCNJ12, L1CAM, and EPHB1were selected and further weighted by their regression coefficients (Figs. 4A-B). The forest plot in Fig. 4C shows that TIGIT is an  independent protective factor with a hazard ratio (HR) < 1 while CHODL is an independent risk factor with HR > 1 for UCEC patients (Fig. 4C). The results suggest that patients with a high expression of CHODL have a poor survival while those with a high expression of TIGIT have a good survival. The whole Cox model also exhibited statistical significance with a concordance index of 0.75. In addition, time-dependent ROC curve analyses in the training set were performed at 1, 3, 5, and 7 years to evaluate the accuracy of prognostic prediction of the m 6 A-related mRNA signature. Figure 4D shows that the maximum AUC is 0.79 at 3249 days, indicating that m 6 A-related genes can serve as biomarkers in the prognosis of UCEC (Fig. 4D). Subsequently, the risk score for each UCEC patient was calculated with the formula generated by the coefficients. The UCEC patients in the training set were separated into highand low-risk subgroups using the median risk score as the cut-off value. Consistent with ROC curve analysis, the Kaplan-Meier curve shows that the UCEC patient risk score is inversely proportional to the clinical outcome (Fig. 4E). Figure 4F shows that the gene signature is enriched in the pathways: collagen type IV sulfilimine cross-linking by peroxidasin, axon guidance receptor activity, cell adhesion molecules, positive regulation of cell morphogenesis involved in differentiation, and negative regulation of lymphocyte activation (Fig. 4F).

Validation of m 6 A gene signature for OS prediction in the testing set
The risk score for each sample in the testing cohort was calculated using the same formula in training set to verify the prognostic ability of the m 6 A gene signature. The UCEC patients in the testing dataset were separated into high-and low-risk groups based on the median risk score. The results were consistent with those in the training dataset. As shown in Fig. 4G, the max AUC is 0.74 at 1314 days (Fig. 4G). Figure 4H shows that patients with higher risk scores have shorter survival and increased death status (P < 0.0001), suggesting that the m 6 A gene signature has a robust and stable OS predictive ability (Fig. 4H). Furthermore, Fig. 5 shows that the expression pattern of the m 6 A gene signature is tumor-specific and most closely related to clinical outcomes in UCEC (Fig. 5). The increased risk is marked in red, and the decreased risk is marked in blue. Except for TIGIT with a decreased risk, the m 6 A signature has an increased risk for survival. The result is consistent with the finding that abnormal m 6 A levels can lead to tumor genesis [9,11]. Figure 6 is the alluvial plot to illustrate the correlation between WERs of m 6 A modification and the m 6 A signature (Fig. 6). Yellow wire represents high confidential targets validated by low-throughput experiments; purple wire represents binding evidence indicated by highthroughput sequencings such as CLIP-Seq, RIP-seq, and ChIP-seq; green wire represents m 6 A WER perturbation followed by high-throughput sequencings such as RNA-Seq, m6A-Seq, and Ribo-Seq [22]. The results show that the proposed m 6 A gene signature closely relates to m 6 A regulators. Therefore, reprogramming m 6 A levels by restoring dysfunction of the m 6 A regulators can directly target the proposed m 6 A gene signature and return to normal expression levels. We explored different RNA modifications other than m 6 A methylation, including N1-methyladenosines (m 1 A), pseudouridine (Ψ) modifications, 5-methylcytosine (m 5 C) modifications, and 2′-O-methylations (2′-O-Me) ( Table 3) to better understand the proposed m 6 A signature. The results show that m 6 A methylation is the main type of modification site in the proposed signature.

In vitro and in vivo experiments to validate the proposed m 6 A gene signature
Then, some in vitro experiments were performed to verify the above assumption. The Ishikawa cell line is by far the most commonly used xenograft model of UCEC. To elucidate the biological functions of CDKN2A, TIGIT, COL4A4, PXDN, CHODL, LMO3, KCNJ12, L1CAM, and EPHB1 in UCEC tumor cells, we knocked down the expression of the 9-gene signature using shRNA or the negative control in Ishikawa cell lines to assess cell proliferation, migration, and invasion in vitro (Fig. 7A). The MTT assay and the colony formation assay demonstrated that tumor proliferation was significantly inhibited in the shCDKN2A group compared with the shCtrl group (P < 0.05, Figs. 7B-C). Transwell assays revealed that Ishikawa cell invasion was significantly reduced after downregulation of CDKN2A (Fig. 7D). Cell migration was evaluated by wound-healing assay. The result shows that decreased expression of CDKN2A significantly inhibits the migration of Ishikawa cells (Fig. 7E). The above results indicate that knockdown of CDKN2A can inhibit the proliferation, migration, and invasion of UCEC tumor

Potential immunological role of the m 6 A gene signature
Since only CDKN2A among all 9 genes was validated to be associated with tumor cells in in vitro and in vivo assays, we speculated that the rest of the genes function from the perspective of immune cells. The correlation between various types of immune cell signatures and each gene of the m 6 A gene signature was explored (Fig. 8). Using the CIBERSORT algorithm, we found that except for CDKN2A, other genes had a certain degree of correlation with immune cells. TIGIT was the gene most strongly associated with immune function and was associated with CD8 + T cells, CD4 + T cells, NK cells, and Macrophage M1 cells with P < 0.001. In contrast, its trend was the opposite for other genes. The result is consistent with the previous results: TIGIT is an independent protective factor with a hazard ratio (HR) < 1 while others are risk factors. These results indicate that CDKN2A may function from the perspective of tumor cells, and CDKN2A, TIGIT, COL4A4, PXDN, CHODL, LMO3, KCNJ12, L1CAM, and EPHB1 may play a role in UCEC from an immunological point of view.

Discussion
UCEC is the most common female pelvic malignancy worldwide. The m 6 A modification, a dynamic and reversible process involving m 6 A regulators, can directly regulate the expression of oncogenes or tumor suppressor genes at the transcriptional level [8], which is closely associated with malignancies. A better understanding of the potential role of m 6 A modification during the tumorigenesis can provide potential biomarkers for early diagnosis and prognosis assessment and new ideas for therapeutic targets [24,25]. Abnormal expression patterns of m 6 A regulators and a reduction in m 6 A methylation have already been found in endometrial cancer [11]. However, the genetic variations, tumor-infiltrating immunological characteristics, and clinical implications involving m 6 A regulators in UCEC remain unknown.
In the present study, we examined the landscape of genetic alterations in the m 6 A regulators of TCGA UCEC patients and found that 28.9% of m 6 A regulators were mutated, suggesting a close relationship between m 6 A methylation modification and endometrial cancer. Among them, the highest frequency of genetic alteration was found in the m 6 A writer gene ZC3H13 (11.9%). The result shows that the function of ZC3H13 is suppressed in UCEC patients, and this dysfunction may be caused by the occurrence of UCEC. ZC3H13 has also been reported to act as a tumor suppressor in breast and colorectal cancer [26,27]. Then, we explored the relevance of genetic alterations, m 6 A gene expression, and the clinical phenotypes of patients with UCEC. Most indicators did not differ significantly between two distinct traits of m 6 A regulator alteration, except that UCEC patients younger than 60 are more likely to have genetic alterations of m 6 A regulators. The result implies that although older patients are more likely to be informed of the risks and symptoms of endometrial cancer, m 6 A modifications may play a role in the occurrence of endometrial cancer in younger patients [28]. Alteration in only one m 6 A regulator can lead to the dysfunction of m 6 A RNA modification. Therefore, we generated an mRNA signature from the outcome-related DEGs by univariate Cox regression followed by LASSO Cox regression after the separation of UCEC patients into two subgroups depending upon the distinction of the m 6 A regulator. Subsequently, a nine m 6 A-related prognostic signature, CDKN2A, TIGIT, COL4A4, PXDN, CHODL, LMO3, KCNJ12, L1CAM, and EPHB1, was developed and performed well for predicting the survival outcome of UCEC patients.
To better understand the proposed m 6 A signature, we explored different RNA modifications other than m 6 A methylation and illustrated the correlation between m 6 A regulators and the proposed signature. The results show that the proposed m 6 A gene signature did have a close relationship with m 6 A regulators. Furthermore, m 6 A methylation is the main modification site in the proposed signature since the direct effects of m 6 A modification on modified transcript expression are established, and the epigenetic reprogramming is more likely manipulated by targeting epigenetic modifiers [29]. Therefore, this m 6 A signature can provide new ideas for diagnosing and treating UCEC from the perspective of epigenetics.
Since RNA-seq data in TCGA is performed using bulk RNA extracted from homogenized tissues, which provide an average number of gene expressions in the pooled population of diverse cells [30], we cannot determine whether the proposed gene signature works in tumor cells or tumor-infiltrating immune cells. Therefore, we used in vitro and in vivo tumor cell experiments and immune correlation analysis to verify the function of each gene in the proposed gene signature. The results show that CDKN2A mainly acts from the perspective of tumor cells, while COL4A4, PXDN, TIGIT, CHODL, LMO3, KCNJ12, L1CAM, and EPHB1 may play a role in UCEC from an immunological point of view. Numerous studies have demonstrated that m 6 A regulators correlate with malignant tumor progression and immunomodulatory abnormality, revealing the special correlation between TME infiltrating immune cells and m 6 A modification [12]. A recent study also shows that abnormal modification behavior of m 6 A can slow down the kinetic rates of mRNA during T cell differentiation due to the increase in naïve T cell numbers from lymph nodes [31]. Therefore, our proposed prognostic m 6 A gene signature may predict immune therapeutic efficacy. Since the present study focused on mining the m 6 A associated gene signature and defined their roles from tumor and immune perspective separately without the mechanistic studies that shows the downstream targets of each gene. We will use our constructed knockdown cell lines for RNA-seq to obtain gene expression profiles of KD cell lines relative to control cell lines that have been subjected to subsequent mechanistic studies.

Conclusions
The abnormal m 6 A modifications are closely associated with the clinical outcome of patients with UCEC. The m 6 A RNA methylation regulator-based prognostic signature can predict the prognosis of UCEC patients and immune therapeutic efficacy from the perspective of epigenetics. Our results will provide a direction for the further exploration of the pathogenesis of UCEC.